The duplication of the urinary tract is a developmental anomaly of the urinary system, which is represented in 0.8% of the population. In most cases, the duplication is incomplete and clinically insignificant. However, in the case of complete duplication, there is possible both an association with such pathologies as ureterocele, vesicoureteral reflux (VUR), urinary incontinence, ureterohydronephrosis and relation to recurrent urinary tract infections. Depending on the identified pathology it is possible to perform surgical interventions. These are organ-displacing operations (heminephroureterectomy) and reconstructive surgery - ureterocystoplasty of the one ureter or both ureters “as a single unit”, as well as the formation of interureteral anastomoses. Currently, there is the possibility to perform both open and endoscopic surgeries. We present a case report of endoscopic minimal invasive reconstructive intervention, performed to patient with ureterohydronephrosis ectopied in the vagina of the urethra of the duplicated left kidney and complaints of urinary incontinence.
Introduction. Circumcisio is a fairly simple, often performed surgical procedure in childhood, which is fraught with a small number of complications (1-5-5%). One of the most rare and dangerous is necrosis of the glans penis. The low incidence of complications determines the lack of a single standardized approach to the treatment of this pathology. The clinical case. In this article, we present a case of glans ischemia after circumcisio with pineal block, corrected with the help of therapy aimed at improving the rheological properties of the blood. A review of the literature and various treatment methods described by other authors was conducted. The exact etiology of ischemia and necrosis of the head in most cases remains unclear. However, numerous possible causes have been described, including spasm of the veins / arteries in the glans penis, thrombosis, hematoma at the injection site, burn during electrocoagulation, perforation of a vein or artery leading to endothelial damage and delayed necrosis. Results. After a course of conservative therapy, local signs of ischemia associated with surgery were stopped without side effects. Discussion.The standard of choice of treatment method for ischemia and necrosis of the glans penis after circumcisio has not yet been established. We have not found an analysis of such clinical cases in children in the domestic literature. A number of foreign colleagues have reported several therapies that have been used with successful results. The ultimate goal of all of these studies was vasodilation to increase arterial inflow and improve venous outflow, which allowed for revascularization of ischemic tissues. Conclusions. Despite the fact that ischemia or necrosis of the glans penis after circumcision is extremely rare, surgeons, urologists need to be wary if patients complain of acute pain or darkening of the color of the glans penis after circumcision of the foreskin.
Сongenital posterior urethroperineal fistula (CUPF) - are extremely rare. This article provides an analysis of 26 cases described in English literature and reported a clinical case illustrating the algorithm of diagnostics and tactics of treatment.
Editrial comment. The described long-term multi-stage surgical treatment – performed at the child's place of residence was not adequate and was the threat of losing the only kidney. Management of patients with a non-reflexing form of megaureter, especially in the neonatal period, requires the assessment of not only the state of the kidney and ureter, but also the state of the bladder, in order to exclude the bladder-dependent form of megaureter. Proximal ureterocuteniostomy, especially of a single kidney, should not be used without a preliminary, full-fledged urological examination. Children with complex malformations of the urinary system should be promptly consulted in specialized medical institutions. Introduction. Among congenital malformations of the urinary system, one of the most common is megaureter. The recently developed surgical techniques and, namely, minimally invasive ones for megaureter treatment, in some cases prevent or delay surgical intervention. However, if deterioration of the renal function is seen, especially in patients with the only functioning kidney, radical surgery has to be performed in a timely manner, before the formation of irreversible changes in the renal parenchyma leading to nephrosclerosis. Purpose. To illustrate a successful surgical outcome in a patient with megaureter in the only functioning kidney when surgeons had to consider all anatomical features after ineffective previous surgical corrections. Material and methods. The authors present a clinical observation and management of a 10-year-old patient with megaureter in the only kidney after previous ineffective surgical corrections when both open traditional methods and long-term endovesical stentings were performed but without taking into account the anatomical localization of the ureteral junction. The patient also developed a latent course of urinary tract infection and chronic kidney disease stage 3 by classification of the National Kidney Foundation (NKF), and the working group on improving outcomes of kidney diseases, Kidney Disease Outcomes Quality Initiative (KDOQI). Results. Despite the existing problems – deficit in the ureter length caused by previous surgeries, impossible endovideosurgical laparoscopy because of metabolic disorders – the performed treatment was successful. The surgeons formed ureterocystoanastomosis by Cohen technique with extra-bladder mobilization of the ureter. Dynamic follow-up after surgical treatment lasted for 2 years. During the observation period, urodynamics of the upper urinary tract was restored and, one could see the elimination of leukocyturia, improvement of blood flow in the parenchyma of the only functioning kidney as well as stabilization of nitrogen metabolic parameters and glomerular filtration rate. Conclusion. While choosing surgical management, surgeons should consider anatomical features of the ureterovesical junction. Such an approach has promoted good results in the discussed case.
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